Healthcare Provider Details

I. General information

NPI: 1578190427
Provider Name (Legal Business Name): MEREDITH MILLER KOWALCZYK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH ANNE MILLER

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CENTRAL AVE
NEW PROVIDENCE NJ
07974-1505
US

IV. Provider business mailing address

550 CENTRAL AVE
NEW PROVIDENCE NJ
07974-1505
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-2215
  • Fax:
Mailing address:
  • Phone: 908-522-2215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01579300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number40QA01579300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: